A few weeks before I started medical school in 1981, the first reports of previously healthy young men with a rare form of pneumonia were released. When I think back on the past 34 years, I remember many patients from the early days of the epidemic who died. I remember the fear of family members, friends and medical staff. I remember the sickening feeling of an accidental needlestick to my finger while caring for a patient with AIDS. I also remember the first patient I spoke with about a brand new drug, AZT, which promised to control the human immunodeficiency virus, the virus that causes AIDS. Her expression was one of concern mixed with cautious hope about what this would mean for her future.
Her hope was not in vain. The progress in the fight against HIV and AIDS has been truly remarkable. More than three dozen drugs are available to suppress HIV and with early diagnosis and effective treatment, life expectancy of a person with HIV is similar to that of the general population. Not only do these drugs limit progression of the disease, but they also reduce transmission of the virus.
Challenges remain. There is still no cure for HIV infection. Fear and stigma still prevent people from receiving the testing and lifesaving medical care that they need. While the rates of transmission have fallen in developed countries, new cases continue to occur. Last year, 42 cases of newly diagnosed HIV infection were reported among Alaskans.
The increase in self-injection of prescription opioid pain relievers and heroin in recent years is a new threat to the prevention and control of HIV. The small town of Austin, Indiana, does not fit the stereotype of an urban area where many of us think HIV is most common. Many of Austin's 4,000 residents, almost all of whom are white, describe themselves as politically and religiously conservative. Yet, over 180 people in Austin have been infected with HIV this year alone. The majority of infections were associated with self-injection of hydromorphone, a prescription opioid pain reliever.
Bold public health inventions appear to have stopped the Indiana outbreak. These efforts included education, aggressive promotion of testing for infection, the availability of clean needles and syringes, and addiction treatment services for people who self-inject. The Indiana outbreak reminds us that HIV can reach into the lives of any one of us, regardless of where we live, our race, our gender or our sexual identity.
On December 1, World AIDS Day, we share our concerns about the future and celebrate the progress to date, the basis of our hope for the future. This day is an opportunity to show support for more than 600 Alaskans living with HIV today and remember 575 Alaskans who have died of AIDS since 1982. It is a day to recognize that, despite the progress, spread of the infection still occurs. If current trends continue, 2 million people will be infected around the world in the next year.
Most importantly, it is a day to remember that HIV can be prevented through safer sexual and injection practices, routine testing for early diagnosis of HIV and other sexually transmitted infections, and increasing availability of safe and effective medications. With these measures, we can share in my patient's cautious hope for a healthier future for all of us.
Jay C. Butler, MD, is chief medical officer for the Alaska Department of Health and Social Services and director of the Division of Public Health.
The views expressed here are the writer's own and are not necessarily endorsed by Alaska Dispatch News, which welcomes a broad range of viewpoints. To submit a piece for consideration, e-mail commentary@alaskadispatch.com